Lately I’ve been trying to be more sincere with my clients. I let them know what is on my mind when appropriate, try to only ask questions when I genuinely want to know the answer, and express myself in a way that is authentic with who I am.
Textbooks tend to mainly talk about being warm and engaging for a good therapeutic alliance, without really mentioning sincerity. To me this feels insufficient. Think of your own interactions where you noticed insincerity, a pushy salesperson or someone at a party with the wrong vibes. They were probably trying to appear warm and engaging too, but something about them put you on guard. As a result, you were probably mistrustful, self-conscious, careful not to share too much. All characteristics that would get in the way of good therapy.
Sincerity might be behind one of the more puzzling findings in therapeutic research. Studies has consistently found no difference in client outcomes between experienced and inexperienced therapists (Germer, et al., 2022, Goldberg, et al., 2016, Vocisano et al., 2004, Wampold & Brown, 2005).
Experienced psychologists will tell you they are more effective than at the start of their career, thanks to knowing more techniques and having more clinical experience - so what explains this discrepancy? One advantage inexperienced therapists have is sincerity. As a new therapist, your clients can read you like a book. You are too terrified of saying the wrong thing for any subterfuge. Perhaps this authenticity makes up for the increased knowledge and techniques of more experienced therapists.
I’ve found that the way a lot of therapeutic techniques are taught make it harder to be sincere as a therapist.
“Ask a client about what emotions they are struggling with, and when they tell you, explain how that relates to the techniques we are teaching.”
Countless therapy textbooks outline suggestions like this, I recently heard something similar in an Acceptance and Commitment Therapy (ACT) course. In this moment, the therapist isn’t really interested in the client’s emotions. The question is just a rhetorical device, designed to increase the client’s commitment to therapy. Put more simply, the therapist is being insincere.
Criticising a therapeutic technique when no one is defending it is easy, so let’s imagine what the ACT course presenter would say in response.
“But this question isn’t central to the therapy,” they might say. “The therapist is just increasing the client’s commitment to the treatment. What matters is when the therapeutic techniques are taught. When that happens the therapist will be sincerely trying to help the client, and that’s what counts.”
To me, this underestimates how unpredictable therapy is. We can’t tell what moments of therapy our clients will find particularly meaningful. Research suggests that the reasons clients improve in therapy are much more complex than the techniques they learn (Wampold & Imel, 2015).
In the above example, perhaps no one has asked them what emotions they are struggling with before. Perhaps just by answering they will learn something about themself, gain insight into their problems. Only in this moment their therapist isn’t interested in what they have to say. For the therapist the question is nothing more than a pre-determined stop on a set of questions they will ask countless clients.
“Ok perhaps some clients will find answering that question meaningful.." “But that can still occur in the above scenario, it’s not like the therapist won’t let them answer.”
And this gets to the heart of my argument. Just asking the right questions then nodding attentively isn’t sufficient for good therapy. You must be sincerely engaged with your clients, genuinely interested in what they have to say. I think this quality of attentiveness is as important as the things said in therapy. Research suggests that the relationship between therapist and client is the best predictor of client outcomes, more important than the type of therapy used (Lambert & Barley, 2001).
Individual therapeutic techniques aren’t the only impediment to sincerity in therapy. I think a lot of the language we use as psychologists can make it harder to maintain a sincere therapeutic presence.
One of my favourite things about being a therapist is the fascinating ways people describe their mental health. I’ve yet to come across two clients who described their mental health in similar ways. It is perhaps useful for researchers to take these descriptions and group them into neat categories like ‘depression’ and ‘anxiety’ but my role with my clients isn’t as a researcher. If I tell myself my client just has ‘depression’ then it is harder for me to muster that same level of curiosity when listening to them.
I find myself classifying the different things they say into DSM-5 checklists. “Ah yes, anhedonia!” while ignoring what makes their anhedonia different from everyone else’s. If, however, I try to understand the client using their own language, it is much easier to maintain a state of curiosity. I'm naturally more interested in what the client has to say, as I’m genuinely trying to understand their story using their own language and ideas.
To be clear, this is all based on my own preferences. Other therapists may be more interested in diagnostic labels, and therefore find it useful to think about their clients in terms of DSM-5 diagnoses and sub-types. The point is I am making a conscious effort to prioritise my own engagement. I do not believe that faked interest in my clients is sufficient, so I need to think about my clients in a way that helps me feel attentive.
This doesn’t mean I ignore research using clinical terms either. They still inform my treatment plans and formulations. However, I recognise that these terms tell only part of the client’s story, and the more I think of the client in their own language, the more engaged with the client I am.
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